Bisexuality and mental health: the double edged sword of stigma

Stephanie Farnsworth examines the stigma faced by those who are bisexual and have mental health issues.

---

The erasure and prejudice bisexual people regularly experience from society and within the LGBTQ+ community can place huge pressures on an individual. It can feel like a constant battle to manage personal well-being in the face of such hostility. Many people struggle to even accept that bisexuality is actually an identity which makes it increasingly difficult for bisexual people to be out, as shown by the fact that they are far less likely to be open about their sexuality. Furthermore, bisexual people have been found to be far more likely to experience substance abuse issues, depression, anxiety, self harm and suicidal ideation than gay or straight people. The isolation and pressures faced can feel intolerable and responses by mental health care professionals are still inconsistent and often lacking in empathy and understanding. Mental health is often neglected, which is often worsened by the lack of awareness still for the specific issues that certain marginalised people face.

Mental health problems can be experienced by anyone, at any time. The responses received for this article aren’t specific to any period of time in their lives; they range from  those who have struggled to come out to those who are at peace with their sexuality, but the common theme is that there is huge stigma associated with being bisexual and managing a mental illness.

One major stereotype that bisexual women with mental health issues experience is jokes and assumptions about their sexuality and how good they are at pleasuring other people. Given the stigma around bisexuality, and how it is often deemed as being insatiable and “greedy”, the two stereotypes often merge together and make it increasingly difficult for bisexual women to be accepted and respected.

“I’m a seventeen year old bisexual and I’ve been diagnosed with Borderline Personality Disorder. Two symptoms of this are usually mentioned in correlation with being bi – “unstable sense of self” and “reckless impulsive behaviour, for example “promiscuity.”

When I’ve spoken about being ill people have immediately been like, “oh, so that’s why your bisexual! unstable sense of self! you can’t pick a side” (which is triggering as hell as it will throw me into a meltdown of WHAT IF THATS TRUE IM SCUM FOR IDENTIFYING AS BI)

Another thing which I get is ‘oh, so your bpd makes you promiscuous? so really you’re not bi, you’ll just do anything with anyone? it’s not like you’re into both you’ll just do whatever'”

At the core is the disbelief of mental health issues and the refusal to accept what it means to be bisexual. Prejudice manifests itself multiple times over to dismiss bi people with mental health problems and reduce them to perverts and sex addicts rather than autonomous human beings with valid identities and feelings as profound as anyone else’s. Their lives and experiences are routinely put up for debate as though the rest of society should control their characters. Autonomy is something sought to be crushed, as is bisexual identity as a whole. The prevalence of such biphobia and mental health stigma regularly leaves those who are vulnerable questioning their entire sense of self, as though they could be flawed just for existing which can lead to extreme self loathing, depression and even suicidal ideation.

“I attended a Mental health day hospital, which had strict rules about racism, but when other patients made biphobic remarks to me, I was supposed to ignore it. I was open about my sexuality, and got treated like a freak because of it in that setting. The LGBT communities are often ableist and biphobic and racist toward me. All of these oppressions impact me negatively and affect my mental health.” Jacq Applebee.

The lack of inclusive and intersectional approaches within health organisations/groups and the LGBTQ+ community are causing the most vulnerable to be left behind when they need support the most. It is a dereliction of duty if healthcare systems are supposed to protect everyone but only serve those they approve of, and it is a failure of the LGBTQ+ community if it can only support and cheer on able bodied, neurotypical, white, cisgender, middle class gay men. It’s an issue made more serious still by the fact that bisexual people of colour are more likely to suffer trauma such as hate crimes, isolation and oppression for their identities in the first place as well as being less able to access mental health services and receive adequate support.

The stigma is such a ubiquitous force that it stops many from even being able to begin to acknowledge their sexuality. One anonymous responder, who is happily married, noted that the stigma surrounding bisexuality meant that for years he could not come to terms with his identity and worried about the reaction of his spouse. This stigma was twofold as while there was stigma surrounding being bisexual, particularly as he grew up in a conservative homophobic family, it also compounded upon mental health issues faced due to the isolation and stress of suspecting he was bisexual. It was a long process with little support, and this silencing of bisexual identities in society made it difficult for him to even begin to explore his own identity: and despite ideas that bisexuals are greedy, this did not lead him to cheat on his wife and while he naturally identifies as polyamorous he has chosen to live in a monogamous relationship with his wife.

What was clear through this respondent’s story was that at no point was there easy (or any) access to support for bisexual people, particularly those questioning their identity. The gay/straight dichotomy in society has increased visibility for gay rights (and even is still far from a perfect situation), but it has left many people feeling confused and as though they are intrinsically wrong for not exclusively liking one gender. There’s little to no awareness of bisexuality as a valid identity and this is clear by the lack of support available for those struggling, and there is also a huge issue of the limited support on offer being fundamentally lacking in its competence.

“Once I had a therapist (she was actually out to me as a gay woman) question whether I was really bisexual. She thought that I was just saying that because I was raped by a man and feeling sexually repulsed by men temporarily. I ended up telling her that I had had sex with women so she would believe me (true, but I shouldn’t have to convince her). She let it go, but I don’t think she every really believed me.” Hannah

Feelings of a lack of support by mental health practitioners and therapists are well documented, and the picture that emerges is one where those working to offer mental health support are usually ill equipped at supporting bisexual people and often perpetuate harm by disregarding sexuality all together or making dangerous comments towards vulnerable bisexual people. It takes a staggering amount of arrogance for anyone to feel that they have the right and knowledge to be able to dictate another person’s identity, and for the individual in the spotlight it can be a very personal form of humiliation and disempowerment to have one’s sexuality erased, especially by someone who is being looked to for support.

What is particularly alarming in this situation is also the idea that abuse somehow leads to sexual orientation, and the connotation with bisexuality with being somehow ‘damaged’. The fact that a gay woman could perpetuate this idea, when this is so often a stereotype thrown at gay women to invalidate their identities further shows how biphobia is often carried out by gay people too.

The idea that bisexuality isn’t real or that one must ‘pick a side’ further seeks to denigrate what it means to be bisexual. It is as common to find this sort of prejudice within the LGBTQ+ world as it is the straight world with bisexual people in mixed gender relationships being cast almost as traitors to the community for the misplaced belief that they in fact benefit from straight privilege, rather than acknowledging that they are in fact experiencing erasure for their sexuality. One anonymous contributor noted how this erasure of mixed gender relationships greatly increased their anxiety and depression.

That therapists would ever take such a controlling and dismissive attitude towards someone they have a duty of care to is horrifying: but hardly unheard of in the history of the existence of LGBTQ+ people. However, the lagging attitudes of those supposed to offer support is jeopardising the health and wellbeing of bisexual people. The issue is made more chronic by the staggering costs of private health care and the fact that even if a bisexual person seeks support outside of the NHS in the UK, there are still many who have never worked with a bisexual person or understand what it means to be bisexual. The result is that biphobia and erasure places huge stresses on bisexual people but when they seek support it is often met with yet more biphobia and erasure, exacerbating the problem and causing even greater distress and isolation.

One survey, ‘The response of mental health professionals to clients seeking help to change or redirect same-sex sexual orientation’ (2009) found that of 1406 questionnaires by practitioners returned, “(17%) reported having assisted at least one client/patient to reduce or change his or her homosexual or lesbian feelings”.

“The 222 professionals who had helped clients to change their sexual orientation then answered the following question: “Given the extent of knowledge about homosexuality and treatments available to change or redirect homosexual or lesbian feelings, are there any circumstances where people should have the opportunity to reduce or redirect their homosexual or lesbian feelings?” One hundred and fifty nine (72%) agreed and 28 (13%) disagreed with the statement, while 35 (15%) gave no answer.”

However, this survey was particularly focused upon the idea of the homosexual/heterosexual dichotomy so while clearly there is great concern for alarm about the vulnerability of gay people seeking mental health support and potentially exposed to the damaging practice of ‘conversion therapy’ the extent to which bisexual people may be subjected to this is harder to gauge. Conversion therapy for sexual orientation has fallen out of favour under scrutiny but it is still not banned in the United Kingdom and ‘reparative therapy’ for trans people is still not seen as even so meeting which should be condemned.

Within the results, it was found that bisexuality in particular was not viewed as a stable or legitimate sexuality by practitioners, with comments suggesting that bisexuality could be altered in some way with enough motivation. The implication being that bisexuality is not a valid sexual orientation but a state of confusion and this can lead to the false believe that there is ongoing issues around sexuality that need resolving and that therefore bisexuality is a cause of ill mental health.

Bisexual people’s mental health is in jeopardy at many points in life. The biphobia, ignorance and erasure of society creates a situation of isolation for many bisexual people but this prejudice is also rooted within healthcare systems meaning that if bisexual people do seek support (and many are not able to), they are often faced with unpleasant and even abusive situations by those who were trusted to give support and thereby exacerbating mental health issues. The lack of funding and resources designed to tackle latent biphobia within healthcare systems means this is a stagnant problem which bisexual people repeatedly have to face, and it is a far worse situation if they are people of colour and/or transgender. Mental health practitioners have a duty to support those who are most vulnerable and yet sadly, they are often doing more harm than good.

Follow Stephanie on Twitter (@StephFarnsworth)